Provider Demographics
NPI:1699191221
Name:WELCH, MARISA (OTD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17055 FRANCES ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4655
Mailing Address - Country:US
Mailing Address - Phone:402-280-2200
Mailing Address - Fax:402-280-2210
Practice Address - Street 1:17055 FRANCES ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:402-280-2200
Practice Address - Fax:402-280-2210
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist